本文關(guān)鍵詞： 趨化因子12 血小板源性生長因子14 視神經(jīng)炎 視神經(jīng)脊髓炎 髓鞘再生　出處：《中國人民解放軍醫(yī)學(xué)院》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：【背景】 視神經(jīng)炎（ON）泛指累及視神經(jīng)的炎性脫髓鞘疾病，它可作為視神經(jīng)脊髓炎（NMO）的首發(fā)癥狀，在臨床上早期往往很難將二者區(qū)分。有報(bào)道稱，大約1/2的NMO患者以孤立視神經(jīng)炎首發(fā)，并且約20%以雙眼同時(shí)發(fā)病。NMO病情較重，急性期80%患者視力嚴(yán)重下降（0.1），60%患者在首次發(fā)病后7.7年內(nèi)單眼或雙眼視力喪失。近年來，髓鞘再生成為脫髓鞘疾病的研究熱點(diǎn)，是脫髓鞘疾病發(fā)生后的重要修復(fù)方式，因此我們猜測可能是腦脊液（CSF）中某些與髓鞘再生相關(guān)的細(xì)胞因子，如血小板源性生長因子（PDGF）、趨化因子12（CXCL12）及趨化因子14（CXCL14）的缺乏或增多，從而導(dǎo)致該疾病的不同結(jié)果。 【目的】 通過檢測ON和NMO患者腦脊液中CXCL12、PDGF及CXCL14的水平和變化，探索ON和NMO新的生物學(xué)標(biāo)記物，，評估其髓鞘再生能力，為ON和NMO的預(yù)后及轉(zhuǎn)歸提供實(shí)驗(yàn)依據(jù)，并為其治療提供新的思路。 【方法】 選取2012年9月至2013年9月期間就診于解放軍總醫(yī)院神經(jīng)眼科的ON患者35人，NMO患者10人及顱內(nèi)靜脈竇血栓形成（CVST）患者10人，收集其臨床資料及腦脊液檢測結(jié)果。用酶聯(lián)免疫吸附劑測定（ELISA）方法檢測腦脊液中CXCL12、PDGF及CXCL14的濃度。比較不同疾病、ON發(fā)病時(shí)期、ON磁共振成像掃描（MRI）表現(xiàn)及ON是否復(fù)發(fā)等腦脊液中CXCL12、PDGF及CXCL14含量的差異，同時(shí)對CXCL12、PDGF及CXCL14含量與白細(xì)胞數(shù)、IgG含量及蛋白含量等參數(shù)進(jìn)行相關(guān)性分析。 【結(jié)果】 ON組和CVST組腦脊液CXCL12、PDGF、CXCL14的水平均明顯高于NMO組患者，其中CVST組患者腦脊液CXCL12、PDGF、CXCL14水平高于ON組；ON急性期組和CVST組腦脊液中CXCL12、PDGF水平比ON平穩(wěn)期組高；35例ON患者中28例進(jìn)行了顱腦或眼眶磁共振成像（MRI）檢查，MRI檢查陽性組的患者腦脊液CXCL12及PDGF水平高于陰性組的患者；此外，腦脊液中CXCL12與PDGF水平變化有顯著相關(guān)性。 【結(jié)論】 腦脊液CXCL12、PDGF及CXCL14水平較低的患者中樞神經(jīng)系統(tǒng)脫髓鞘更為嚴(yán)重，三者可能成為ON和NMO等中樞神經(jīng)系統(tǒng)脫髓鞘疾病的新的生物診斷標(biāo)記物；在ON的不同階段，監(jiān)測腦脊液CXCL12和PDGF可以評估其病情變化，判斷預(yù)后情況；如果在ON急性期之后適當(dāng)補(bǔ)充CXCL12或促進(jìn)機(jī)體自身合成CXCL12，可能促使視功能更快地恢復(fù)；鞘內(nèi)注射CXCL12和PDGF可能成為治療中樞神經(jīng)系統(tǒng)脫髓鞘疾病的新方法。
[Abstract]:[background]
Optic neuritis (ON) refers to the optic nerve involvement of inflammatory demyelinating diseases, it can be used as neuromyelitis optica (NMO) starting in the early clinical symptoms, it is often difficult to distinguish between the two. Reports about 1/2 NMO patients with isolated optic neuritis first, and about 20% in two eyes at the same time.NMO serious illness, serious loss of vision in 80% acute stage (0.1), 60% patients in 7.7 years in monocular or binocular vision loss for the first time after the onset of remyelination. In recent years, become a hot research topic in demyelinating diseases, is an important restoration after the occurrence of demyelinating diseases, so we speculate may be in cerebrospinal fluid (CSF) some remyelination related cytokines, such as platelet-derived growth factor (PDGF), chemokine 12 (CXCL12) and chemokine 14 (CXCL14) deficiency or increased, which lead to different results of the disease.
[Objective]
By detecting the levels and changes of CXCL12, PDGF and CXCL14 in cerebrospinal fluid of ON and NMO patients, we explored new biomarkers of ON and NMO, evaluated their myelin regeneration ability, and provided experimental evidence for prognosis and prognosis of ON and NMO, and provided new ideas for their treatment.
[method]
From September 2012 to September 2013 during the period of treatment in neuro ophthalmology of PLA General Hospital 35 ON patients, 10 NMO patients and cerebral venous sinus thrombosis (CVST) in 10 patients, the clinical data collection and detection. The results of cerebrospinal fluid were determined by enzyme linked immunosorbent assay (ELISA) method in CXCL12 detection of cerebrospinal fluid concentrations of PDGF. And CXCL14. Comparison of different diseases, the incidence of ON during the period of ON, magnetic resonance imaging (MRI) and ON is CXCL12 recurrence in the cerebrospinal fluid, the difference of PDGF and CXCL14 content, while the CXCL12, PDGF and CXCL14 content and the number of white blood cells, the correlation analysis of parameters of IgG content and protein content.
[results]
ON group and CVST group PDGF, cerebrospinal fluid CXCL12, CXCL14 levels were significantly higher than that of group NMO, group CVST PDGF, CXCL14 in cerebrospinal fluid of patients with CXCL12 were higher than ON group; ON group and CVST group in acute phase in cerebrospinal fluid CXCL12, PDGF levels than the ON stationary phase group; 35 cases of ON patients were 28 cases the brain or orbital magnetic resonance imaging (MRI) examination, examination of cerebrospinal fluid in patients with MRI positive group and PDGF negative group was higher than CXCL12 patients; in addition, there was a significant correlation between the changes of CXCL12 and PDGF in cerebrospinal fluid.
[Conclusion]
Cerebrospinal fluid CXCL12, demyelinating central nervous system in patients with PDGF and lower levels of CXCL14 is more serious, the three may be ON and NMO and other demyelinating disease of the central nervous system of new biological diagnostic markers; in different stages of ON, CXCL12 and PDGF can evaluate the monitoring of cerebrospinal fluid changes in their condition, prognosis; if after acute ON supplement CXCL12 or promote the body's own synthesis CXCL12, may cause visual function recover faster; intrathecal injection of CXCL12 and PDGF may become a new method for the treatment of demyelinating disease of the central nervous system.

【學(xué)位授予單位】：中國人民解放軍醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R774.6

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